Provider Demographics
NPI:1053057919
Name:BONSU, MAGDALENE
Entity Type:Individual
Prefix:DR
First Name:MAGDALENE
Middle Name:
Last Name:BONSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19915 HORIZON BLF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3150
Mailing Address - Country:US
Mailing Address - Phone:682-552-4700
Mailing Address - Fax:
Practice Address - Street 1:19915 HORIZON BLF
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3150
Practice Address - Country:US
Practice Address - Phone:682-552-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist